Jean Hall RECIEVED
•
700 STATEMENT OF ECONOMIC INTERESTS D (�FIR'Ba�" Received
CALIFORNIA FORM ue a
FAIR POLITICAL PRACTICES COMMISSION MAR 2 8 2017
A PUBLIC DOCUMENT COVER PAGE
CITY CLERK'S OFFICE
Please type or pool in ink.
BY:
NAME OF FILER LAST) (FIRST) {MIDDLE)
r
Hall Jean Li
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Rosemead Traffic Commissioner
Division, Board. Depadment District, if applicable Your Position
. If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency. Position:
2. Jurisdiction of Office (Check at least one box)
0 Stale ❑Judge or Court Commissioner(Statewide Jurisdiction)
o Multi-County ❑County of
0 City of Rosemead _ - []Other-_
3. Type of Statement (Check at least one box)
(AAnnual: The period covered is January t, 2016, through ❑ Leaving Office: Date Let--_. J__ /__
December 31, 2016. (Check one)
or-
The period covered is J___i —, through C) The period covered is January 1, 2016, through the date of
December 31, 2016, or leaving office.
❑ Assuming Office: Date assumed / /_- C) The period covered is L. _J._ , through
the date of leaving office.
O Candidate: Election year and office sought, if different than Part 1:
4. Schedule Summary (must complete) ip. Total number of pages including this cover page:
Schedules attached
Schedule A-1 . Investments-schedule attached ❑Schedule C Income, Loans, 8 Business Positions-schedule attached
[�ypchetlule Aa • Investments-schedule attached El Schedule 0 -Income- Gins-schedule attached
L.1 Schedule B-Real Properly-schedule attached ❑Schedule E -income- Gifts- Travel Payments-schedule attached
-or-
O None • No reportable interests on any schedule
—
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended•Pub&Document)
8838 E. Valley Boulevard Rosemead CA 91770
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
( 626 ) 569-2100
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
t-s-c� 7 - a__
Date Signed Jam�T -_ Signature
:mak.ney,year) Ai (File the mglnally sgned 9element with your fling official
FPPC Form 700(2016/2017)
FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/215-3772 www.fppc.ca.gov
•
SCHEDULE A-1 CALIFORNIA FORM 700
Investments FAIR POLITICAL PRACTICES COMMISSION
Stocks, Bonds, and Other Interests Name / /
��R(Ownership Interest is Less Than 10%) A) C
Do not attach brokerage or financial statements.
a- NAME OF BUSINESS ENTITY D • NA E OF BUSINESS ENT TY
‘7,(// I-4/2. I 4 L.Jq ve it/G5 6/71 datc/ )c l✓€5leRo/ AS �3 C4-06e, 0
GENERAL DESCRIPTION OF THIS BUSINESS GENERAL9ESCRIPTION OF THIS BUSINEFS
C h Say;,l y s e-i/Cc/C,.J
FAIR MARKET VALUE FAIR MARKET VALUE
❑ $2.000-$10000 $10,001 - $100,000 ,r $?000 -$10,009 ❑ $iwullt -sun 900
LI$100,001 -$1 000000 Over$1,000.000 �S $100001 -$1.000000 ❑ Over Si 000,00
NATURE OF INVESTMENT NATURE OF INVESTMENT
❑ Stock ]other ] Stock ]Other
(Describe) (Describe)
fl Partnership 0 Income Received of$0-$499 n Partnership C)Income Received of$0-$499
0 Income Received of$500 or More(Report on SnnWnk C) 0 Income Received of$500 or More(Rayon an Schedule C)
IF APPLICABLE, LIST DATE. IF APPLICABLE, LIS1 DATE.
__i_j 16 _/_/ 16 __j_J_ 116 _/_J 16
ACQUIRED DISPOSED ACQUIRED DISPOSED
irs NAME OF BUSINESS ENTITY • NAME OF BUSINESS E TIN
/374-01/.k." r"F 14rne e,cA 115m4.) A , ztiC-R datC j, K'J ?s4-o�vA CA
GENERAL DESCRIPTION OF THIS BUSINESS / GENERAL DESCRIPTION OF THIS BUSIryc55
C >410e5-:,e/,1/y CIS 5
FAIR MARKET VALUE FAIR MARKET VALUE
cg$2,000-S10.000 ] ¶10.001 -8100 000 0 $2,000-$10,000 ❑ $10,001 -$198000
] $100,001 -$1 00.000 ]over$1,000.000 x $100.001 - $1000000 ]over$1,000,000
NATURE OF INVESTMENT NATURE OF INVESTMENT
E Stock Li Other ____- _ ❑ Stock ❑Other _.
(Describe) (Desoto)
•
❑ Partnership 0 Income Received of$0-$499 ] Partnership O Income Received of$0 .5499
O Income Received of$500 or More meson on Schedule C) 0 Income Received of$500 or More(Report on Schedule c)
IF APPLICABLE, LIST DATE. IF APPLICABLE, LIST DATE.
_t_f 16 _._.-/ 1 16 j 116 _j_/ 16
ACQUIRED DISPOSED ACQUIRED DISPOSED
• NAME OF BUSINESS ENTITY K NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE FAIR MARKET VALUE
❑ $2,000-$10,090 ] $19001 -$100,000 ❑$2,000 -$10.000 ❑ $19001 -$100,000
❑$109001 -$1,000,000 ]Over$1000.000 0 $100.001 - $1.009000 ❑ Over $1009000
NATURE OF INVESTMENT NATURE OF INVESTMENT
] Stock ]Other — ] Stock ]Other
(Describe) (Describe)
] Partnership 0 Income Received of$0-$499 D Partnership 0 Income Received of$0-$499
o Income Received of$500 or More(Report on Schedule 0) 0 Income Received of$500 or More(Report on Schedule C)
IF APPLICABLE, LIST DATE. IF APPLICABLE, LIST DATE
_/_/ 16 / -_--J 16 _J___/ 16 _/_/ 16
ACQUIRED DISPOSED ACQUIRED DISPOSED
Comments:
FPPC Form 700(2016/2017)Sch.A-1
FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov
SCHEDULE A-2 CALIFORNIA FORM 700
Investments, Income, and Assets
FAIR°°LIT""LPRACTICES eDMM1551°"
of Business Entities/Trusts Nam
(Ownership Interest is 10% or Greater)
���N � - /�Af L
x
•1. BUSINESS ENTITY OR TRUST
• Al AN _ ,Cy Fe-rs7 _
Name Name
3Lss?/ otitsc4c- cAvr- /05.20
Address(Business Address Acceptable) Address (Business Address Acep( er )
Check one Check one
❑ Trust. go to 2 ❑ Business Entity. complete me box. men go to 2 [i Trust.go to 2 Ti Business Entity. complete the box. Nen go to 2
GENERAL DESCRIPI ION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE IF APPLICABLE, LIST DATE. PAIR MARKET VALUE IF APPLICABLE LIST DATE.
O $0-51999 e3p-iF- ( 9 L] so-$1,999
[] 52.000-510.000 Jliter / j 16 L] $2,000- $10000 _J- /-16 - ,- /__ Lifi_ -
1] 810.00, -5100,000 ACQUIRED DISPOSED ❑ 510001 - $100.000 ACQUIRED DISPOSED I
�[y- $100.001 . 51.000,000 [i II $100.00, -$1.000,000
pi over$1,000,000 H Oven $1.000000
NATURE OF INVESTMENT NATURE OF INVESTMENT
❑Partnership ❑Sole Proprietorship El- - ❑ Partnership ❑ Sole Proprietorship [I- _
Oomer
•
YOUR BUSINESS POSITION - -- - YOUR BUSINESS POSITION_
IP 2. IDENTIFY THE GROSS INCOME RECEIVED(INCLUDE YOUR PRO RATA 2. IDENTIFY THE GROSS INCOME RECEIVED(INCLUDE YOUR PRO RATA
SHARE OF THE GROSS INCOME LQ THE ENTITY/TRUST) SHARE OF THE GROSS INCOME TO THE ENTITYITRUSTI
❑ so- $4s9 LI sl0001 - $100000 IT) so-&99 ❑ 510.001 - VOODOO
❑ $500-$1000 I_I OVER 8100,000 ❑ $500 -$1,000 ❑OVER$100,000
❑ $1,001 -$10000 ❑ stool -$10,000
• 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF 510,000 OR MORE mach a aeparels meets necessary l INCOME OF 510,000 OR MORE math a tevnae sheer it necessary I
❑ None or 0 Names listed below ❑ None or Names listed below
•4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR
LEASED BY THE BUSINESS ENTITY OR TRUST LEASED a'THE BUSINESS ENTITY OR TRUST
Check one box Check one box
[] INVESTMENT [] REAL PROPERTY f INVESTMENT [- REAL PROPERTY
Name of Business Entity, if Investment, or Name of Rusinesc Entity. if lnvestmeni. o
Assessor's Parcel Number or Street Address of Real Property Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or Description of Business Activity or
City or Other Precise Location of Real Property City or Omer Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE FAIR MARKTI VAI 11E IF APPLICABLE, LIST DATE.
❑ $2.000 -$10.000 ❑ $2,000 -$10,000
[] $1a um -$1DODoo _J___
.,16 _
. i.__i 16. ❑ Sm 001 - si00000 _.. /___/-16 j j 16
LI$100,001 -$1,000,000 ACQUIRED DISPOSED ❑ $100,001 - $1,000.000 ACQUIRED DISPOSED
over 51.000,000 ❑ over$1,000,000
NATURE OF INTEREST NATURE OF INTEREST
fl Property OwnecUnp/Deed or Trust ❑ Stock L] Partnership L] Property Owne,rshiplDeed of hull Ii Stock ❑ Partnership
Li Leasehold ._ ❑ Other_. L] Leasehold - __ I_] Other
yrs rnmaining Yrs.remaining
E Check box if additional schedules reporting lin estments or real property ❑ Check box d addilronal schedules reporting investments or real property
are attached are attached
FPPC Form 700(2016/2017)Sch.A-2
Comments:_ - -- ----- __ FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov
CALIFORNIA FORM 700
SCHEDULE B FAIR POLITICAL PRACTICES COMMISSION
Interests in Real Property Name
(Including Rental Income) - -
/F�fly 714LL
of ASSESSOR'S FARCE NUMBER OR STREET ADDRESS le ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
,3L Ss 111 t,cs<a ri:: c AIA- , / 1 n.re-/2 E-NGd A✓k
CI CITYin
t -'0-5 frig Ca. 1`'/770 PA'S./_bE 4 CA
/ r--
FAIR MARKET VALUE IF APPLICABL rLIST DATE. FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
U sz,000-sm,000 19 U 0 $2,000-$10000 /0-4.2-0.a
U signet -$l00000 i'iii —/—/ 16 r $loam .$100000 _I___L 111- _i_i 16
❑ $100,001 -$1000000 ACQUIRED DISPOSED $100001 -$1,000 000 ACQUIRED DISPOSED
U Over$+000.000 U Oyer$1000000
NATURE OF INTEREST NATURE OF INTEREST
Ownership/Deed of Trust U Easement U Ownership/Deed of Trust ❑ Easement
❑ Leasehold_. - U— _ —___. .._ U Leasehold—. ❑ .--
Yrs remaining goer Yrs remaining Other
IF RENTAL PROPERTY,GROSS INCOME RECEIVED IF RENTAL PROPERTY. GROSS INCOME RECEIVED
U $0-$099 0$500-$+000 ❑ stool -stems ❑ $o-$499 7ssoo-$1.000 Ustool - $10.000
U $10001 -$100,000 ❑ OVER$100.000 ] $10001 -$100,000 U OVER$100000
SOURCES OF RENTAL INCOME. If you own a 10% or greater SOURCES OF RENTAL INCOME. If you own a 10% or greater
interest, list the name of each tenant that is a single source of interest, list the name of each tenant that is a single source of
income of$10,000 or more. Income of$10,000 or more.
❑ None 0 None
*
You are not required to report loans from commercial lending institutions made in the lender's regular course of
business on terms available to members of the public without regard to your official status. Personal loans and
loans received not in a lender's regular course of business must be disclosed as follows:
NAME OF LENDER' NAME OF LENDER'
ADDRESS (Business Address Acceptable) ADDRESS(Busmese Address Acceptable)
BUSINESS ACTIVITY, IF ANY OF LENDER BUSINESS ACTIVITY, IF ANY. OF LENDER
INTEREST RATE TERM(Months/Years) INTEREST RATE TERM (Months/Years)
° ❑ None % U None
HIGHEST BALANCE DURING REPORTING PERIOD HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500-$1000 ❑ $1,001 -s10.000 E $500-$1,000 0 $1o01 -$10000
❑ $10,001 -$top000 ❑ OVER$100,000 ] $10,001 -$100000 U OVER $100,000
❑Guarantor, If applicable ❑Guarantor, if applicable
Comments:
FPPC Form 700(2016/2017)Sch.B
FPPC Advice Email:advice@tppc.ca.gov
FM"TnIJ Irpn Helnlinn•Rfis1 7G-3779 www inn.-ra one